Welcome to Delta Dental! 2021-22 Open Enrollment - A dental election is REQUIRED if you want dental insurance coverage for yourself and your ...

 
Welcome to Delta Dental! 2021-22 Open Enrollment - A dental election is REQUIRED if you want dental insurance coverage for yourself and your ...
Welcome to Delta Dental!
2021-22 Open Enrollment

A dental election is REQUIRED if you want dental
insurance coverage for yourself and your family in the
new plan year!
Welcome to Delta Dental! 2021-22 Open Enrollment - A dental election is REQUIRED if you want dental insurance coverage for yourself and your ...
Delta Dental
PPO™
Welcome to Delta Dental! 2021-22 Open Enrollment - A dental election is REQUIRED if you want dental insurance coverage for yourself and your ...
The Delta Dental Difference®

   Delta Dental PPO          Delta Dental Premier®   Non–Delta Dental

                      • Visit a PPO dentist to
                        save the most.
                      • You can visit any
                        licensed dentist.
                      • You won’t be charged
                        more than your
                        expected share of
                        the bill.
Welcome to Delta Dental! 2021-22 Open Enrollment - A dental election is REQUIRED if you want dental insurance coverage for yourself and your ...
Delta Dental PPO
                            In-Network           – &
                                              Premier
                                PPODelta
                                    BASEDental  PPO –
                                         PLANNon-Delta
                                $75 perBASE  PLAN
                                        person,
                                  Employee      PPO
                                             Pays
                                     providers
                                      Employee Pays
Diagnostic   and
     Deductible               $100 per person, Premier
preventive
Comprehensivecare year
     Per calendar              0%& Non-Contracted50%
(exams, cleanings,
orthodontics    – CHILD                    50%
                                     providers
x-rays,
ONLY sealants)                     Waived for D&P
Basic   services
Comprehensive
       Annual
       maximum
(Fillings, simple (Adult)            Not covered
                                               30%
orthodontics                20%$1,500 per person
extractions, root year
      Per calendar                            (after
                    (after deductible) $1,500
Lifetime
canals, gumMaximum                         deductible)
     Orthodontic
treatment)
                                 $1,500 per person
MajorLifetime maximum
       services                                  80%
(Crowns, oral                  70%
                                                (after
surgery, bridges,      (after deductible)
dentures)
                                             deductible)
Welcome to Delta Dental! 2021-22 Open Enrollment - A dental election is REQUIRED if you want dental insurance coverage for yourself and your ...
Your PPO coverage
BUY-UP PLAN

                                               In-Network        Premier &
                                                     Delta DentalNon-Delta
                                                   PPO            PPO –
                                                        BUY-UP PLAN
                                                       Delta Dental
                                                       Employee PaysPPO –
                                                         $50 per person
                                                          BUY-UP    PLAN
                        Deductible
                    Diagnostic  and
                        Per calendar
                                                         $150 per family
                    preventive  careyear          0%       Employee
                                                          Waived       Pays
                                                                       20%
                                                                 for D&P
                    (exams, cleanings,
                      Comprehensive
                         Annual
                    x-rays,        maximum
                            sealants)                           50%person
                                                        $2,000 per
                      orthodontics
                         Per calendar(child)
                    Basic services     year
                      Comprehensive
                    (Fillings, simple              20%
                           Orthodontic
                    extractions,  root                         50% 50%
                      orthodontics     (adult)
                           Lifetime maximum            $2,000 per
                                           (after deductible)     person
                                                              (after deductible)
                    canals, gum
                      Lifetime
                    treatment)Maximum                         $2,000
                    Major services
                    (Crowns, oral               50%                70%
                    surgery, bridges,   (after deductible) (after deductible)
                    dentures)
Pre-treatment estimate
DeltaCare® USA DHMO
The DHMO is available in the following states:

•    Alabama              •   New Jersey             *The Delta DHMO is only
                                                     available in approved
•    Arizona              •   New York
                                                     states – the following are
•    Arkansas             •   North Carolina         pending approval:
•    Delaware             •   Pennsylvania           • California (pending)
•    Florida              •   South Carolina         • Colorado (pending
                                                     • Maryland (pending)
•    Illinois             •   Tennessee
                                                     • Ohio (pending)
•    Indiana              •   Texas                  • Oregon (pending)
•    Kansas               •   Virginia               • Washington (pending)
•    Michigan             •   Washington DC
•    Mississippi          •   Wisconsin
•    Missouri

                                                                          *Pending as of 12/14/2020
Comprehensive coverage
DeltaCare USA DHMO: a prepaid, fixed copayment plan

                                           DHMOenrolled,
                                           Once    benefit enhancements
                                                           select a primary
                                           dentist from the DeltaCare USA
                                           include:
                                           network
                                              • 178tomore
                                                       startcovered
                                                             enjoying:
                                                                     DHMO
                                              • procedures;
                                                 Set copays all-inclusive
                                              • copays
                                                 No annual maximums
                                              •• Posterior composite fillings
                                                 No deductibles
                                                 covered
                                               • No claims
                                               • No missing tooth exclusion
                                               • Low premiums
                                               • Implants covered
                                               • Tooth whitening covered
How DeltaCare USA DHMO works
Getting dental care is easy
Specialty and emergency care
DeltaCare USA DHMO

  • If you need specialty care, your
    primary care dentist will refer you
  • Your primary care dentist requests
    authorization for specialty services
  • Plan includes out-of-network coverage
    for emergencies
All about braces
DeltaCare USA DHMO

• Orthodontic coverage for children and adults
• All phases of orthodontic treatment are covered
• Pre-and post-records
• Tooth extractions
• Coverage for in-progress treatment
• Sampling of pre-set copays (please refer to full summary for additional details):
Teeth Whitening & Implants
     New with the DeltaCare USA DHMO

                                                                      DeltaCare USA
                                                                      Your copayment*
  Teeth Whitening
  External bleaching for home application,
  per arch; includes materials and                                     $125 copayment
  fabrication of custom trays
  Implants
  Surgical placement of implant body:
                                                                      $1,005 copayment
  endosteal implant
  Custom fabricated abutment – includes
                                                                       $425 copayment
  placement
  Abutment supported porcelain/ceramic
                                                                       $740 copayment
  crown
*Limitations and exclusions may apply. Sample listing of procedure codes. Please reference plan booklet for complete listing of covered
procedure codes.
Go to deltadentalins.com to browse the DeltaCare USA
dentists in your area.
Write down the facility number of the primary care
dentist you would like.

Submit your request
  •   Online: Create an online account at
      deltadentalins.com
  •   By phone: Call Customer Service at 800-422-4234

Each member school will document dentist election
and communicate to Delta Dental. If no election is
made, a provider will be auto assigned. Providers can
be changed anytime throughout the year.
Web and mobile
resources
Sign up for an online account
Check your benefits information online –
deltadentalins.com

     •   Check your plan details: eligibility, covered
         services and level of benefits.
     •   Look up claim statements for recent dental visits.
     •   View or print your ID card.
     •   Estimate the cost of your next procedure.
     •   Submit questions to Customer Service.
Go mobile

            What can you do with the app?

            To find the app, visit the App Store or Google Play and
            search for “Delta Dental.” Then download the Delta
            Dental app by Delta Dental Plans Association.
Find a network dentist

 •   Go to deltadentalins.com.
 •   Look for the Find a Dentist tab.
 •   Search by name, address, landmark, city or ZIP code.
 •   Select your network plan.
 •   Click Search.
 •   Narrow your search by location, specialty, network and
     language.
 •   Your search results will include a dentist’s Yelp rating,
     address and phone number.
Cost Estimator
Budget for dental expenses with personalized
estimates

 Personalized. Estimates are based on your
 benefits, including maximums and deductibles.
 Insightful. Compare the cost of the same
 procedure at different dentists.
 Economical. See how choosing an in-network
 dentist can help you save.
Value Added Service: Savings you can hear!
Access hearing aid and LASIK discounts
Now available to you and your dependents

  Amplifon Hearing        62% average savings off retail
    Health Care           hearing aid pricing

                          40-50% off traditional LASIK
      QualSight           eye surgery
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